Category : News Coverage

Authorities arrested Andrea Michelle Tellison, owner of Texas Durable Medical Company, following a 21-count indictment charging her with healthcare fraud and aggravated identity theft. From the FBI Website: Durable Medical Equipment Company Owner Arrested in 21-Count Health Care Fraud Indictment HOUSTON—Andrea Michelle Tellison, 46, has been arrested following the return of a 21-count indictment charging her with health care fraud and aggravated identity theft, United States Attorney Kenneth Magidson announced today. The indictment was returned under seal Wednesday, March 20, […]

The Medicare audit reform bill, introduced by Reps. Sam Graves (R-Mo.) and Adam Schiff (D-Calif.), will weaken the federal government’s flagship healthcare program. FROM RACMonitor: “Every year, more than $65 billion in improper payments are made to healthcare providers due to fraud, waste, abuse, and billing errors,” Amanda Keating, a spokesperson for the American Coalition for Healthcare Claims Integrity, said in a written statement to RACmonitor. “This puts a tremendous burden on a Medicare system already struggling to remain […]

POLITICO Pulse exposes the special interests driving RAC reform efforts in the House. FROM POLITICO PULSE: It didn’t take long for the bipartisan harmony presented by the sponsors of the Medicare Audit Improvement Act to devolve into a mud fight. Primary sponsors, Rep. Sam Graves (R-Mo.) and Adam Schiff (D-Calif.), presented the bill as an effort to ease the administrative burden on small hospitals by restricting Medicare fraud contractors’ ability to make onerous document requests. But a chorus of […]

Reps. Sam Graves (R-Mo.) and Adman Schiff (D-Calif.) have introduced new legislation to limit auditing activities within a certain timeframe. FROM THE HILL’s HEALTHWATCH: The measure would limit the number of “additional document requests” to two percent of hospitals claims, with a maximum of 500 per 45 days. It would also penalize auditors that ignore basic audit requirements and courtesies. A non-profit anti-fraud group criticized the bill. “While we have not had an opportunity to review the legislation in […]

From the FBI Website: Houston-Area Doctor Sentenced to 63 Months in Prison for Role in $17.3 Million Medicare Fraud Scheme WASHINGTON—A Texas doctor was sentenced today to serve 63 months in prison for conspiring to commit health care fraud by falsifying plans of care for Medicare beneficiaries, including patients whom he did not treat, as part of a $17.3 million Medicare fraud scheme. Today’s sentence was announced by Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division; U.S. Attorney […]

POLITICO Pulse examined ACHCI’s effort to prevent Congress from restructuring vital healthcare auditing programs. FROM POLITICO PULSE: The American Coalition for Healthcare Claims Integrity is asking Congress not to pass legislation that would hurt programs targeting health care fraud and waste — noting that provisions in the health care law have recovered $10.7 billion since 2009, mostly improper payments in Medicare and Medicaid. “Our coalition members have a proven track record of helping return significant funds to government health […]

In this story, the Washington Post reports that the federal government lost $261 billion, or 7 percent of total spending, to fraud and waste in 2012. FROM THE WASHINGTON POST: “Despite progress in reducing improper payments, federal agencies continue to lose billions annually to waste, fraud and abuse. The federal government lost $261 billion, or 7 percent of total spending, to fraud and waste in 2012, said Rep. Darrell Issa (R-Calif.) during a February House committee hearing. Though improper […]

A federal jury finds an Orange County doctor and nine other defendants guilty in a multi-million-dollar healthcare fraud case. FROM THE U.S. ATTORNEY’S OFFICE: Orange County Doctor Convicted Of Six Counts Of Health Care Fraud In Multi-Million Dollar Scam Involving Durable Medical Equipment FOR IMMEDIATE RELEASE March 7, 2013 LOS ANGELES – A federal jury has convicted a Buena Park doctor for participating in a health care fraud scheme involving unnecessary procedures and prescriptions that led to Medicare paying out nearly […]

This week, authorities pursued two major cases of hospital fraud in Texas and Florida, respectively. In both cases, providers overbilled the government by millions. FROM FIERCE HEALTHCARE: According to federal prosecutors, Driscoll Children’s Hospital-owned Children’s Physician Services of South Texas and Radiology Associates each billed the government for the same procedure over five years, resulting in at least $12.3 million in wrongful reimbursement, according to the report. (…) Meanwhile, a whistleblower lawsuit filed against Florida Hospital continues in federal court […]